Integration and co-location of HIV/AIDS, tuberculosis and drug treatment services

Abstract

Injection drug use (IDU) plays a critical role in the HIV epidemic in several countries throughout the world. In these countries, injection drug users are at significant risk for both HIV and tuberculosis, and active IDU negatively impacts treatment access, adherence and retention. Comprehensive strategies are therefore needed to effectively deliver preventive, diagnostic and curative services to these complex patient populations. We propose that developing co-located integrated care delivery systems should become the focus of national programmes as they continue to scale-up access to antiretroviral medications for drug users. Existing data suggest that such a programme will expand services for each of these diseases; increase detection of tuberculosis (TB) and HIV; improve medication adherence; increase entry into substance use treatment; decrease the likelihood of adverse drug events; and improve the effectiveness of prevention interventions. Key aspects of integration programmes include: co-location of services convenient to the patient; provision of effective substance use treatment, including pharmacotherapies; cross-training of generalist and specialist care providers; and provision of enhanced monitoring of drug-drug interactions and adverse side effects. Central to implementing this agenda will be fostering the political will to fund infrastructure and service delivery, expanding street-level outreach to IDUs, and training community health workers capable of cost effectively delivering these services.

The prevalence of comorbidities among people living with HIV in Brent: a diverse London Borough

“…43 Such holistic services also provide the opportunity to combine HIV treatment with other diseases such as other infections like hepatitis. 44 The experience of extracting the data for this audit highlighted the need for systems to routinely record comorbidities. Further, many services still used paper records.…”

Short- and long-term mortality and causes of death in HIV/tuberculosis patients in Europe

“…It is likely that optimising TB and HIV management alone for these patients will not resolve the high mortality rates. There is a need for a multidisciplinary approach, also involving access to opiate substitution therapy, social and psychological assistance [36,37].…”

Problematic Alcohol Use Among Individuals with HIV: Relations with Everyday Memory Functioning and HIV Symptom Severity

“…Identification of cognitive deficits prior to treatment would afford clinicians the opportunity to modify intervention delivery and preemptively recruit organizational and community resources. Finally, our results highlight the importance of integrated care for this high-risk population [e.g., 14, 101] that includes crosstraining initiatives across health disciplines (e.g., memory and alcohol screening), co-location of services [102], enhanced provider communication, monitoring of drug interactions and side effects, and a united, multidisciplinary team approach to combating the serious social and economic consequences that typify HIV infection and substance use.…”